We surveyed to which extent the processes of examination and treatment in 2012 were based on guidelines based on evaluated scientific evidence within the Hospital District of Helsinki and Uusimaa. The survey was directed at the fulfillment of 31 Current Care guidelines and 19 HALO guidelines, four nursing science guidelines as well as one physiotherapeutic guideline in a total of 1,318 patients. Current Care guidelines were mainly fulfilled well. Poor fulfillment of drug recommendations after hospitalization was alarming. HALO guidelines were moderately well fulfilled, whereas there were defects in adherence to the nursing science and physiotherapeutic guidelines.
Clinical guidelines have been the subject of much criticism in primary care literature partly due to potential conflicts in their implementation among patients with multiple chronic conditions. We assessed the relevance of selected Canadian clinical guidelines on chronic diseases for patients with comorbidity and examined their quality.
We selected 16 chronic medical conditions according to their frequency of occurrence, complexity of treatment, and pertinence to primary care. Recent Canadian clinical guidelines (2004 - 2009) on these conditions, published in English or French, were retrieved. We assessed guideline relevance to the care of patients with comorbidity with a tool developed by Boyd and colleagues. Quality was assessed using the Appraisal of Guidelines Research and Evaluation (AGREE) instrument.
Regarding relevance, 56.2% of guidelines addressed treatment for patients with multiple chronic conditions and 18.8% addressed the issue for older patients. Fifteen guidelines (93.8%) included specific recommendations for patients with one concurrent condition; only three guidelines (18.8%) addressed specific recommendations for patients with two comorbid conditions and one for more than two concurrent comorbid conditions. Quality of the evaluated guidelines was good to very good in four out of the six domains measured using the AGREE instrument. The domains with lower mean scores were Stakeholder Involvement and Applicability.
The quality of the Canadian guidelines examined is generally good, yet their relevance for patients with two or more chronic conditions is very limited and there is room for improvement in this respect.
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Every newborn has a right to efficient resuscitation on demand in all Finnish delivery units. All delivery units must have a round-the-clock readiness for emergency C-section and resuscitation of the newborn, and medical doctors capable of these must be immediately available. Every newborn should be evaluated for the need for resuscitation. When needed, resuscitation should be started without delay. Resuscitation of the newborn includes stimulation, ventilation, chest compressions and other hemodynamic support, ventilation being the most important of these. Regular training is required to maintain and improve the resuscitation skills of the personnel.
The paper presents guidelines in treating tuberculosis in children from the experience gained in Russia and other foreign countries. Emphasis is laid on the necessity of applying a comprehensive approach to the treatment whose main constituents are sanitary and dietary regimens, etiotropic and pathogenetic therapies, prevention of exacerbations or treatment of concomitant diseases. It is important to use antituberculous agents rationally by determining a standard treatment regimens for patients with various somatic diseases. Of great value is the pattern of organization of a therapeutical process at different stages (institutional treatment at a hospital, day hospital, or sanatorium and outpatient treatment), which secures continuity and accordingly enhances the efficiency of treatment as a whole.